Xanthoma and Xanthelasma
What is Xanthoma and Xanthelasma?
Xanthoma and xanthelasma are visible deposits of cholesterol that form under your skin. Xanthelasma appears as yellowish patches around your eyelids, usually near the inner corner. Xanthomas are larger bumps that typically develop on tendons, especially around your elbows, knees, hands, feet, and Achilles tendons.
These deposits form when cholesterol levels in your blood become severely elevated over time. The excess cholesterol accumulates in certain tissues and creates these characteristic yellowish growths. While they are not painful or dangerous on their own, they signal underlying cholesterol problems that can lead to heart disease.
Both conditions are strongly linked to familial hypercholesterolemia, a genetic condition that causes extremely high cholesterol from birth. They can also occur with other lipid disorders or long-term poorly controlled cholesterol levels. Detecting and treating the underlying cholesterol problem is essential for your heart health.
Symptoms
- Yellowish patches or plaques on eyelids, usually on both sides
- Painless bumps on tendons, particularly Achilles tendons and finger tendons
- Firm, raised nodules on elbows, knees, or buttocks
- Yellowish discoloration visible through the skin
- Gradual growth of deposits over months or years
- No pain or itching in most cases
Many people notice the cosmetic appearance of xanthelasma before any other symptoms. The deposits themselves do not cause health problems directly, but they indicate dangerously high cholesterol levels that may have no other obvious signs.
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Causes and risk factors
The primary cause is severely elevated LDL cholesterol, the type that builds up in arteries and tissues. When LDL cholesterol levels exceed 300 mg/dL, which commonly occurs in familial hypercholesterolemia, cholesterol begins depositing in skin and tendons. Familial hypercholesterolemia is an inherited genetic condition affecting about 1 in 250 people. People with this condition have extremely high cholesterol from birth due to defective LDL receptors.
Other causes include poorly controlled high cholesterol over many years, certain liver diseases, diabetes, low thyroid function, and rare lipid disorders. Obesity and a diet high in saturated fats can worsen cholesterol levels. Family history is a major risk factor, as genetic forms of high cholesterol run in families. Age also plays a role, as xanthelasma becomes more common after age 40, though it can appear earlier with genetic conditions.
How it's diagnosed
Diagnosis begins with a physical examination of the characteristic yellowish deposits. Your doctor will recognize xanthelasma and xanthomas by their appearance and location. Blood tests are essential to measure your cholesterol levels and identify the underlying lipid disorder. LDL cholesterol testing is the key diagnostic tool, as severely elevated levels confirm the cause of your deposits.
Rite Aid offers testing for LDL cholesterol through our flagship panel at over 2,000 Quest Diagnostics locations. This helps identify dangerous cholesterol levels before complications develop. Your doctor may also order genetic testing if familial hypercholesterolemia is suspected. Additional tests might include triglycerides, total cholesterol, HDL cholesterol, and liver function tests to understand your full lipid profile.
Treatment options
- Statin medications like atorvastatin or rosuvastatin to lower LDL cholesterol dramatically
- PCSK9 inhibitor injections for severe or genetic high cholesterol
- Ezetimibe to reduce cholesterol absorption from food
- Dietary changes including reducing saturated fats and trans fats
- Increasing fiber intake through vegetables, fruits, and whole grains
- Regular aerobic exercise at least 150 minutes per week
- Weight loss if overweight or obese
- Avoiding smoking and excessive alcohol
- Surgical removal or laser treatment for cosmetic concerns
- Regular monitoring of cholesterol levels every 3 to 6 months
Lowering LDL cholesterol can cause xanthomas and xanthelasma to shrink or disappear over time. Treatment focuses on preventing heart disease and stroke, which are the serious complications of severely high cholesterol. Work closely with your doctor to find the right medication combination for your cholesterol levels.
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Frequently asked questions
Xanthelasma specifically refers to yellowish cholesterol deposits on or around the eyelids. Xanthomas are cholesterol deposits that form on tendons and other body areas like elbows, knees, and hands. Both are caused by severely elevated cholesterol levels, but they appear in different locations with slightly different appearances.
The deposits themselves are not dangerous and do not cause pain or health problems directly. However, they are warning signs of severely elevated cholesterol, which dramatically increases your risk of heart attack and stroke. The underlying cholesterol problem requires immediate treatment to protect your cardiovascular health.
Xanthomas typically develop when LDL cholesterol levels exceed 300 mg/dL, though they can sometimes form at lower levels with long-term exposure. Normal LDL cholesterol is below 100 mg/dL. Levels above 190 mg/dL suggest familial hypercholesterolemia, and levels above 300 mg/dL significantly increase the risk of cholesterol deposits.
Xanthelasma rarely disappears without treatment of the underlying high cholesterol. Once formed, the deposits tend to persist or grow larger over time. However, lowering LDL cholesterol through medication and lifestyle changes can cause the deposits to shrink or resolve completely over months to years.
While severely elevated cholesterol is the most common cause, about 50% of people with xanthelasma have normal cholesterol levels. In these cases, the deposits may relate to local cholesterol metabolism issues, age, or other lipid abnormalities. However, everyone with xanthelasma should have their cholesterol tested to rule out dangerous elevations.
A simple blood test measuring LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides identifies the problem. Rite Aid offers testing for LDL cholesterol through our subscription service at over 2,000 Quest Diagnostics locations nationwide. Testing should be done after fasting for 9 to 12 hours for the most accurate results.
Diet alone is rarely sufficient when cholesterol levels are high enough to cause visible deposits. While reducing saturated fats, trans fats, and dietary cholesterol helps, most people need medication to lower LDL cholesterol adequately. Combining dietary changes with statin therapy or other medications produces the best results and prevents cardiovascular disease.
Yes, if you have xanthomas or severely high cholesterol, your children should be tested by age 10. Familial hypercholesterolemia is inherited, and children with this condition have extremely high cholesterol from birth. Early detection and treatment prevent heart disease and allow xanthomas to be avoided entirely with proper management.
Surgical excision, laser treatment, and chemical peels can remove xanthelasma for cosmetic reasons. However, the deposits often recur if the underlying cholesterol problem is not treated. Lowering LDL cholesterol to healthy levels is essential to prevent recurrence after removal and to protect your heart health.
With effective cholesterol lowering, xanthomas may begin to shrink within 6 to 12 months. Complete resolution can take several years of maintaining low LDL cholesterol levels. Xanthelasma tends to be more stubborn and may not disappear completely even with excellent cholesterol control, though it often becomes less prominent.